Prescribing is one of the most high-stakes tasks in clinical practice. Whether you are a hospital doctor, GP, or nurse prescriber, your signature carries significant legal and clinical weight.
As the saying goes, “Drugs are poisons with occasional beneficial side effects.”
Use these 10 principles to minimize errors and optimise patient outcomes.
Never prescribe a drug you aren’t familiar with simply because it was suggested by someone else.
Stick to what you know: Maintain a “personal formulary” of 20 drugs you understand deeply (indications, contraindications, and side effects).
Consult the BNF: If you are prescribing outside your comfort zone, always check the British National Formulary (BNF).
Utilise Pharmacists: Ward or community pharmacists are your best allies, and they will know alot more than you. If a dose looks high or an interaction is possible, ask them before signing.
A prescription is only as good as the history it is based on.
The “Brown Bag” Review: Ask patients to show you exactly what they are taking, not just what is on their repeat list.
Identify Discrepancies: Hospital, GP, and Pharmacy records often disagree. Reconciling these is the first step to preventing a medication error.
Prescribing a known allergen can be fatal and is a “Never Event” in many healthcare settings.
Define the Reaction: Always distinguish between a true allergy (e.g. anaphylaxis, rash) and a side effect (e.g. nausea).
The Golden Rule: Prescribing nothing is often safer than prescribing without a confirmed allergy history.
Sometimes, the best prescription is no prescription at all.
Natural History: Most minor viral illnesses resolve within two weeks without intervention.
Risk vs. Benefit: Every drug carries a “burden of treatment.” If the risk of side effects outweighs the marginal benefit, withhold the drug.
In geriatric medicine, deprescribing is often more important than starting new treatments.
Focus on Quality of Life: At age 89, the long-term preventative benefit of a statin is negligible compared to the immediate risk of myalgias or falls.
Falls Prevention: Review medications that cause orthostatic hypotension or sedation (e.g., antihypertensives, benzodiazepines).
Clinical guidelines are often written for 50-year-olds with single diseases. They must be adapted for the multi-morbid elderly.
Permissive Targets: For an 82-year-old with Type 2 Diabetes, an HbA1c of 52 mmol/mol or a BP of 140/90 mmHg may be safer than aggressive control that risks hypoglycaemic episodes or faints.
Don’t “fiddle” with complex specialty medications if they are outside your expertise. And don’t change things for the sake of it (e.g. new slighly better treatment). As they say ‘Up North’, ‘if it’s not broke, don’t fix it’.
Specialist Leads: Medications for HIV, Epilepsy, or Transplant Rejection should generally be managed by the relevant specialist. If you suspect an issue, contact the lead consultant or GP rather than altering the dose yourself.
Most prescribing errors occur at the “interface of care” (discharge or referral).
Written Instructions: Give the patient a clear, written note of any changes.
Digital Integration: Use tools like Accurx or digital discharge summaries to send instant, clear instructions to the GP (e.g., “Hypercalcemia detected: Please stop Vitamin D and Calcium supplements immediately”).
Patients often stop taking new medications within six months.
The “Add-on” Trap: Clinicians often add new drugs because “the first one didn’t work,” when the reality is the patient simply stopped taking it.
Check and Recheck: Regularly ask: “How many doses have you missed in the last week?” Use a non-judgmental tone to get an honest answer.
Prescribing is 10% science and 90% communication.
Educate the Patient: If they don’t understand why they are taking a drug, they won’t take it correctly.
Learn from Mistakes: In your early years, minor errors are inevitable. Treat them as “Near Misses”—analyze why they happened, discuss them in supervision, and adjust your process.
| Patient Group | Strategy | Key Goal |
| Paediatrics | Weight-based dosing | Safety/Accuracy |
| Young Adults | Compliance education | Long-term health |
| Frail Elderly | Deprescribing | Fall prevention |
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